We will be having a panel discussion at our medical school, sponsored by our student AMWA group (which I am involved in), among other groups. I have helped come up with a few questions with my friend who is president of the research group (about publishing negative study outcomes, for example). I wanted to write up some questions regarding the recent HHS rule issue. Here is what I cam up with. FYI, most of the members of the panel will be osteopathic physicians. One panel member (Dr. P) is a lawyer, PhD and MPH who teaches culture and illness related courses in our MPH program.
The US Dept of Health and Human Services (HHS) was writing up a new rule regarding women’s reproductive health care: link
It got leaked to the public. The rule primarily intends to extend the anti-discrimination laws, which already prohibit hiring employment discrimination based on religion, to specifically protect health care practitioners who want to exercise conscience clauses during the hiring process at federally funded clinics. (Health care practitioners who refuse to dispense or participate in any procedure or treatment that could be construed as morally objectionable, which the rule goes on to clarify as most forms of birth control and abortion, and includes refusing to refer to another practitioner or facility which would provide the health care that they are refusing to provide. The rule, other than a one word reference to euthanasia, spends extensive time discussing many aspects of reproductive health which may be morally objectionable to practitioners, including providing emergency contraception to rape victims.)
This rule would require that any clinic, hospital, research facility, etc. that provides any form of health care and receives federal funds cannot include willingness to provide these services as a prerequisite for hiring. This would include family planning clinics funded by the department of health, university hospitals, student pharmacies, military hospitals, rural clinics in underserved areas that get practitioners due to incentives from the National Health Service Corps or Indian Health Network, clinics receiving Title X funding to improve access to birth control to low income women and men, and any facility that accepts Medicaid or Medicare. Even if the main purpose of the facility is to provide (or research) birth control and family planning services, they will not be able to base hiring on an ability and willingness to provide these services.
In the language of the rule, the HHS also seeks to change two medical definitions to ideological definitions that would be legally very troubling. They define pregnancy as starting at fertilization of the egg, not at implantation, and define a fertilized egg as a human being. While this may be consistent with the most restrictive religious definitions, these definitions are not consistent with any medical definition, including that of ACOG (American College of Obstetrics and Gynecology). The rule also discusses specific forms of birth control, including emergency contraception, and supports non medical descriptions of their actions, defining them as abortificients.
ACOG, the AMA, and many other (mostly allopathic) organizations have written strongly worded statements condemning the rule. The rule was apparently written with a conservative political interest group, the Family Research Council, not with medical experts as consultants. A former Family Research Council staffer, Susan Orr, helped draft the rule when she was the Assistant Deputy Secretary of Population Affairs, the department responsible for overseeing access to contraception services for low income men and women. She was appointed to oversee Title X funding, even though she publicly declared that birth control is not a medical necessity, since fertility is not a disease.
ACOG statement: link
In response to the reaction from medical organizations, the Secretary of the HHS, Mike Leavitt, has posted an official statement. He downplays the strongly ideological language of the rule, and says that the intent of the rule is to allow patients and doctors to line up with similar beliefs.
(link – they keep shifting the address, but this is the most current).
(Note to my fellow AMWA officer: OK, D, I know this is a lot of background, but this is a complicated issue. I think this would be an excellent question for Dr. Perez from the public health school. She teaches Culture and Illness, and I think the Secretary’s response that health care should be exclusionary towards people of other belief systems would be a good topic for her. If you are emailing them the background, maybe this would save them from having to do a lot of reading about it)
Question intro: Prominent medical organizations such as the American Medical Association and the American College of Obstetrics and Gynecologists have issued statements condemning a recent proposed rule by the Department of Health and Human Services. This rule would extend discrimination law to health care practitioners being hired at federally funded clinics who want to exercise conscience clauses, especially those who will refuse to provide contraception, terminations, and referrals to these services. This follows a history of complaints from professional medical organizations that this administration has been using ideology to shape federal health care policy, including FDA drug approvals, rules, and appointments to important departmental positions, in ways that are contrary to conventional professional medical community recommendations.
Question for physicians: How can organizations like the AOA, SOIMA, and ACOG become more involved in shaping federal health policy and preventing excessive political interest group influence?
Question for Dr. P: The secretary of Health and Human Services defended extending protection of conscience clauses by saying that patients should be able to select physicians who share the same beliefs. Do you think federal agencies should be promoting this as a goal? Do you think conscience clauses for practitioners who want to deny health care services and referral to health care services are a way to help patients find practitioners who share their belief systems?